Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
Institute of Work, Employment and Society, University of Professional Studies, Accra, Ghana.
PLoS One. 2023 Nov 16;18(11):e0279528. doi: 10.1371/journal.pone.0279528. eCollection 2023.
The COVID-19 pandemic has led to substantial interruptions in critical health services, with 90% of countries reporting interruptions in routine vaccinations, maternal health care and chronic disease management. The use of non-pharmaceutical interventions (NPIs) such as lockdowns and self-isolation had implications on the provision of essential health services (EHS). We investigated exemplary COVID-19 outbreak control strategies and explored the extent to which the adoption of these NPIs affected the provision of EHS including immunization coverage and facility-based deliveries. Finally, we document core health system strategies and practices adopted to maintain EHS during the early phase of the pandemic.
This study used an explanatory sequential study design. First, we utilized data from routine health management information systems to quantify the impact of the pandemic on the provision of EHS using interrupted time series models. Second, we explored exemplary strategies and health system initiatives that were adopted to prevent the spread of COVID-19 infections while maintaining the provision of EHS using in-depth interviews with key informants including policymakers and healthcare providers.
The COVID-19 pandemic and the interventions that were implemented disrupted the provision of EHS. In the first month of the COVID-19 pandemic, Oral Polio and pentavalent vaccination coverage reduced by 15.2% [95% CI = -22.61, -7.87, p<0.001] and 12.4% [95% CI = 17.68, -7.13; p<0.001] respectively. The exemplary strategies adopted in maintaining the provision of EHS while also responding to the spread of infections include the development of new policy guidelines that were disseminated with modified service delivery models, new treatment and prevention guidelines, the use of telemedicine and medical drones to provide EHS and facilitate rapid testing of suspected cases.
The implementation of different NPIs during the peak phase of the pandemic disrupted the provision of EHS. However, the Ministry of Health leveraged the resilient health system and deployed efficient, all-inclusive, and integrated infectious disease management and infection prevention control strategies to maintain the provision of EHS while responding to the spread of infections.
COVID-19 大流行导致关键卫生服务受到严重干扰，90%的国家报告常规疫苗接种、孕产妇保健和慢性病管理受到干扰。封锁和自我隔离等非药物干预措施（NPIs）的使用对基本卫生服务（EHS）的提供产生了影响。我们调查了典型的 COVID-19 疫情控制策略，并探讨了这些 NPI 的采用程度对包括免疫接种覆盖率和基于设施的分娩在内的 EHS 提供的影响。最后，我们记录了在大流行早期为维持 EHS 而采用的核心卫生系统战略和做法。
本研究采用解释性序贯研究设计。首先，我们利用常规卫生管理信息系统的数据，使用中断时间序列模型量化大流行对 EHS 提供的影响。其次，我们探讨了在预防 COVID-19 感染传播的同时维持 EHS 提供的典型策略和卫生系统举措，方法是对政策制定者和医疗保健提供者等主要信息提供者进行深入访谈。
COVID-19 大流行和实施的干预措施扰乱了 EHS 的提供。在 COVID-19 大流行的第一个月，口服脊髓灰质炎和五联疫苗的接种覆盖率分别减少了 15.2%[95%CI=-22.61，-7.87，p<0.001]和 12.4%[95%CI=17.68，-7.13；p<0.001]。在维持 EHS 提供的同时应对感染传播所采用的典型策略包括制定新的政策指南，这些指南通过修改后的服务提供模式进行传播，新的治疗和预防指南，使用远程医疗和医疗无人机提供 EHS 并促进疑似病例的快速检测。
在大流行高峰期实施的不同 NPI 干扰了 EHS 的提供。然而，卫生部利用有弹性的卫生系统，部署了高效、全面和综合的传染病管理和感染预防控制策略，在应对感染传播的同时维持 EHS 的提供。
